Prescription of sedative drugs during hospital stay: A Swiss prospective study.

In recent years, the number of prescriptions for sedative drugs has increased significantly, as has their long-term use. Moreover, sedative use is frequently initiated during hospital stays. This study aimed to describe new prescriptions of sedative drugs during hospital stays and evaluate their maintenance as discharge medication. This observational prospective study took place in an internal medicine ward of a Swiss hospital over a period of 3 months in 2014. Demographic (age, sex, diagnosis, comorbidities) and medication data [long-term use of sedative drugs, new regular or pro re nata ('as needed') prescriptions of sedative drugs, drug-related problems] were collected. Sedative medications included: benzodiazepines, Z-drugs, antihistamines, antidepressants, neuroleptics, herbal drugs, and clomethiazole. McNemar's test was used for comparison. Of 290 patients included, 212 (73%) were over 65 years old and 169 (58%) were women; 34% (n = 98) were using sedative drugs long term before their hospital stay, and 44% (n = 128) had a prescription for sedative drugs at discharge-a 10% increase (p < 0.05). Sedative drugs were newly prescribed to 37% (n = 108) of patients during their stay. Among these, 37% (n = 40) received a repeat prescription at discharge. Over half of the sedative drugs were prescribed within 24 h of admission. Drug-related problems were detected in 76% of new prescriptions, of which 90% were drug-drug interactions. This study showed that hospital stays increased the proportion of patients who were prescribed a sedative drug at discharge by 10% (absolute increase). These prescriptions may generate long-term use and expose patients to drug-related problems. Promoting alternative approaches for managing insomnia are recommended

Bronchopneumopathie chronique obstructive décompensée : stratégie ventilatoire

Lors de bronchopneumopathie chronique obstructive décompensée, la ventilation mécanique (VM) a pour but d'améliorer l'oxygénation, de corriger l'hypoventilation alvéolaire et l'acidose, de mettre les musdes «au repos» et d'assurer la fonction respiratoire jusqu'à résolution de la crise. Dans cette première phase, la VM peut s'effectuer à travers un tube endotrechéal (VM invasive) ou un masque facial ou nasal (VM non invasive). Les indications de ces deux approches et des modes ventilatoires sont passées en revue. La VM non invasive instaurée précocement - quand faire se peut et en l'absence de contre-indications - permet de diminuer la durée de séjour hospitalier et la mortalité